POS0601 CRANIOCERVICAL JUNCTION INVOLVEMENT ASSESSED BY COMPUTED TOMOGRAPHY AND/OR MAGNETIC RESONANCE IMAGING IN INFLAMMATORY ARTHRITIS: SINGLE CENTER CASE-CONTROL STUDY
Authors: F. Yalçinkaya, Ş. Parlak, E. Bilgin, K. Karli Oğuz, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2022)

Background Craniocervical involvement is generally overlooked clinically. Objectives The aim of this study is to investigate the craniocervical involvement in inflammatory arthritidies and compare with patients without inflammatory arthritidies. Methods In this retrospective analysis, cervical CT and/or MRI scans -taken for any reasons between 2010 and 2020 - of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) (M05, M06, M07 and M45) according to ICD-10 codes were scanned from the hospital database. The diagnosis of RA, AS, and PsA was confirmed by an experienced clinician with medical history, laboratory, and treatment history. Of these patients, those who underwent CT and/or MRI before the definitive diagnosis of inflammatory arthritis were included in the analyses. Demographic data of the included patients were recorded. Craniocervical involvements (anterior, posterior, lateral, and rotational atlantoaxial subluxation; vertical subluxation; subaxial subluxation; odontoid process involvement [resorption or pannus], atlantoaxial and atlantooccipital involvement) were evaluated by an experienced radiologist on CT or MRI, as appropriate. Control group was consisted of consequent patients without inflammatory arthritidies and who undergone cervical CT or MRI with any reasons out of trauma. p&lt;0.05 was considered statistically significant. Results From a total of 4442 records (1558 individual patients), 459 patients (204 RA, 200 SpA, and 55 PsA patients) and 78 patients for control group were included in the study. In Table 1, comparison of RA, SpA and control groups was given. The percentage of female gender and age at diagnosis were lower in SpA patients. Craniocervical junction involvement was detected in 101 (49.5%) RA, 53 (26.5%) SpA, 4 (5.1%) of control group, p&lt;0.001. The odontoid process appears to be one of the main targets at the craniocervical junction, especially in RA patients (69 (33.8%)) which was significantly higher than SpA and control groups. Atlantoaxial subluxation and atlantoaxial joint involvement were significantly higher in RA and SpA groups than control group. Although vertical subluxation (VS) was numerically higher in RA nd SpA groups compared to control group, VS-related brainstem compression was relatively uncommon (6 (2.9%) in RA, 1 (0.5%) in AS, none of the control group. Spinal cord compression was detected in 8 (7.9%) RA patients and 2 (1.0%) AS patients and none of the control group. Regarding PsA, percentage of overall craniocervical involvement was higher than control group (16.4% vs 5.1%) without precedence of any specific involvement. Table 1. Comparison of RA, SpA and control groups for spesific types of craniocervical involvements Conclusion Craniocervical junction involvement can often be detected in patients with inflammatory arthritis, especially in patients with RA. Odontoid process seems as the main target of inflammation. Craniocervical involvement has the potential to be overlooked clinically, and needs to be evaluated more carefully. Disclosure of Interests None declared